Clark, Chad Alan

Clark, Chad Alan is an individual health care provider with primary practice located at 58 Glenroyal Dr , Pueblo CO 81005-2174. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Clark, Chad Alan can be contacted via phone (719) 565-6678.

Contact Information

Primary practice address
58 Glenroyal Dr Pueblo CO 81005-2174
Phone: (719) 565-6678
Fax: (719) 561-0577
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 5835 Colorado

Profile Details

NPI number 1083617906
LBN Legal business name Clark, Chad Alan
Credentials MSPT
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Sep 1st, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083617906 NPPES
Colorado MEDICAID 36630233

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